Men’s Health A-Z

Erectile Dysfunction

Erectile Dysfunction

What is erectile dysfunction?

Erectile dysfunction (ED) is when a man finds it difficult or impossible to produce or sustain an erection. It is the most common male sexual disorder, and is associated with many chronic conditions, including cardiovascular disease, diabetes, metabolic syndrome, and prostate cancer. Lifestyle factors (like obesity and smoking) also increase risk of erectile dysfunction.

There are many conditions and medical treatments that increase the likelihood of sexual disorders:

  • Psychological: depression, anxiety, stress, and relationship problems
  • Pharmaceutical drugs: antidepressants, NSAIDs, and antihypertensives
  • Cardiovascular disease
  • Cancer treatments: surgery, radiation, chemotherapy, and hormone therapies
  • Diabetes and Metabolic Syndrome
  • Hormonal disorders
  • Trauma to the genital area
  • Thyroid problems
  • Spinal cord injury
  • Multiple Sclerosis

Sexual health is strongly related to overall health and quality of life. Poor lifestyle choices and the presence of chronic disease increase the likelihood of sexual disorders. Lifestyle interventions that encourage smoking cessation, weight loss, and increased physical activity play a part in treating sexual disorders. For example, weight loss and increased physical activity have proven helpful for patients with both erectile dysfunction and cardiovascular disease.

Erectile dysfunction is also called:

  • sexual dysfunction
  • impotence
  • male erectile disorder

If you’re suffering from erectile dysfunction, you’re not alone: approximately 50% of men between ages 40 and 70 have erectile dysfunction. It is more common in older men and in men with conditions like heart disease, high cholesterol, and diabetes. Men treated for prostate cancer with surgery, radiation, or hormones often have erectile dysfunction.

What causes erectile dysfunction?

Some of the causes of erectile dysfunction include:

  • Aging
  • Disease or injury
  • Medications such as anti-depressants and blood pressure drugs
  • Stress
  • Fatigue
  • Anxiety, depression, or low self-esteem

Underlying conditions such as diabetes, atherosclerosis, vascular disease, and metabolic syndrome can be risk factors for erectile dysfunction, as can lifestyle choices like smoking, drinking alcohol (usually excessively), and being overweight.

What are the symptoms of erectile dysfunction?

The symptoms of erectile dysfunction include:

  • trouble getting or keeping an erection
  • erections that are not hard enough for sexual intercourse
  • inability to maintain an erection after penetration
  • reduced sexual desire

Often, the symptoms of erectile dysfunction cause problems between a man and his partner, which encourages him to seek help.

What is the treatment for erectile dysfunction?

Fortunately, there are many successful treatments available for erectile dysfunction. The most publicized treatment is Viagra, which was introduced to the market in March 1998. If you experience erectile dysfunction, the first step is to make an appointment with your family physician. He or she may order lab tests, perform a physical exam, or schedule an ultrasound to check blood flow to the penis before recommending treatment.

“There are many options we have that can assist somebody to get an erection adequate for penetration,” says Dr. Elliott. Treatment may involve making lifestyle changes, such as losing weight or quitting smoking, or switching to medications with fewer sexual side effects. Or, your physician may refer you to a sex therapist, prescribe ED medications, or suggest using a vacuum device to draw blood into the penis.

What are the treatment options for erectile dysfunction?

Fortunately, there are many successful treatments available for erectile dysfunction (ED).

Some of these include:

Oral Medications

Medications such as Sildenafil citrate (Viagra), Vardenafil (Levitra), and Tadalafil (Cialis) help improve blood flow to the penis, and, combined with sexual stimulation, produce an erection. These medications are generally safe, although they cannot be used by men who take nitrates for heart problems.

Vacuum Erection Devices

Vacuum erection devices are specifically designed to help create an erection. The device is fitted over the penis, and a simple hand pump reduces the pressure in the air around the penis, helping to draw blood into the spongy tissue. A rubber ring is then placed at the base of the penis to maintain the erection (this should be removed within 30 minutes). Vacuum erection devices have no serious side effects, and for some men are all that is required.

Watch Dustin Olson, specialist at Timm Medical Technologies, explain vacuum erection devices.

Injection Therapy

The patient injects a special medication (or combination of medications) directly into the base of the penis, using a tiny thin needle. The needle is similar to the ones that diabetics use daily for injecting insulin. The medications that are injected work on the blood vessels in the penis, opening up the arteries and closing the veins. The erection produced with injection therapy is generally a good quality erection that can last for an hour or more. Injection therapy is often successful even if the nerves have been injured during radiation therapy or surgery.

Watch Sexual Medicine physician Dr. Stacy Elliott discuss and demonstrate the penile injection technique.

Urethral Suppository

This method uses the same type of medication that is used in the injection technique. The medicine, alprostadil, is available in the form of a tiny pellet that is inserted in the urinary opening. As the medication dissolves, it works on the blood vessels in the penis to cause an erection.

Penile Implants

There are two types of surgical implants: one produces a permanent bendable erection, while the other type is inflatable. This surgery is irreversible; therefore, this treatment option is rarely considered.

Watch American Medical Systems Canada specialist Col Hallas discuss options for men considering penile implants.

Counselling and Therapy

ED can impact a man and his partner emotionally and psychologically. Counselling can help reduce the stress and anxiety associated with ED. Combined with other treatments, counselling can reduce the time it takes to regain sexual function.

Can erectile dysfunction signal heart problems?

Erectile dysfunction is a problem many men don’t want to talk about, but their lives could depend on it, say doctors.

While drugs like Viagra, Cialis, and Levitra can help the condition, the trouble is they may only be treating a symptom for something much more serious.

Sexual medicine physician Dr. Stacy Elliott said ED can be a clue to other serious health issues, acting as much of a red flag for heart disease as smoking or a family history.

“Erectile dysfunction is now being looked at as a canary in the coal mine for cardiovascular disease,” Elliott told CTV News.

Like your age, the younger you are the more likely ED is a sign you’re at risk of heart disease. Men under 50 are especially high risk. It’s the same story if you have ED and diabetes, depression, or high blood pressure.

But many young men might be ignoring the problem. While most people think of ED as something men in their golden years deal with, it also can affect middle aged and younger men.

More than 50 per cent of men in their 50’s have issues. But so do one-third of men in their 40’s and 10 per cent of men between 18 and 24-years-old.

Still, only one in 10 actually see their doctors about the problem.

“I think one of the most common misconceptions around erectile dysfunction is that it’s ‘all in your head,’” Elliott said.

Couples and sex therapist Dr. David McKenzie said he always advises his clients with any kind of sexual dysfunction that may have a physiological basis to see their medical doctor for a blood test.

“And every other kind of test you can get to rule out any physical pathology,” he said.
The good news is that a healthy lifestyle, including not smoking, can improve your cardiovascular health—and performance in the bedroom.

What’s my 10-year outlook for Erectile Dysfunction and other health concerns?

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